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APPIC Match Service Helps Veterans Hosp Psychologists Discriminate against Applicants w/ Disabilitie
J Wyatt Ehrenfels · 12/08/03 at 7:55 ET
Extreme Prejudice: Psychologists Discriminate against Applicants with Disabilities
WARNING: The following material is not suitable for persons whose identity, self-esteem, or mental health depends on faith in the psychological community. Additional details with an evidentiary bearing above and beyond those authorized for release in this document will be incorporated into expanded drafts.
Background on the Process of Applying for Internship in Psychology
Students pursuing a doctorate in clinical psychology, and ultimately a license, are no strangers to applications. They apply to graduate school. They apply to three yearlong practical and supervised training experiences. The first two of these training experiences, known as externships or practica, are part-time (16-20 hrs/wk), unpaid positions performed locally and while the student fulfills course requirements. The third is a full-time and typically stipended (~$12-22K per annum) capstone experience contingent on the completion of course requirements and which may be fulfilled locally but for which, in the vast majority of instances, a student relocates to another city or region.
Students seeking internships are expected to spread applications across an average of 10-12 institutions nationally. Institutions, which include but are not limited to counseling centers, universities, and veterans hospitals, receive inexpensive labor in exchange for training a student in a realistic and supervised environment complete with workshops, seminars, and guidance in preparation for the national licensing examination. The application process is facilitated by a managed exchange of information and guidelines among the applicant, the training director at the school in which the applicant is enrolled, and the institution hosting the internship. This exchange has been orchestrated by the Association of Psychology Postdoctoral and Internship Centers (APPIC) since its inception in 1968. By no means a passive medium, APPIC has established policies and standards as well as forums for the discussion of issues related to internship and the application process. Any institution interested in offering an internship (and any student interested in applying for internship) must register with APPIC and abide by its policies.
One APPIC policy in particular has facilitated discrimination against applicants with disabilities. The policy of non-disclosure exempts internship sites from requests for information concerning the specific ranking of an intern applicant and the grounds on which the ranking was decided by the committee reviewing applications and interviewing applicants.
I found myself in a position to collect some rather unsettling facts about one student's epic journey through the process of applying for internship.
Not Just Another Applicant
We'll call her NJAA, short for 'not just another applicant.' While the vast majority (close to 100%) of the applicants for internship have not finished a doctoral degree, NJAA had already earned a Ph.D. in Social-Personality Psychology and an M.A. in Developmental Psychology, two fields related to the second (practitioner's) doctorate (PsyD) on which she was closing in. The PhD and M.A. certify her skills as a producer (as well as consumer) of knowledge in the field of Psychology as well as provide additional scope and depth to her background knowledge of human nature. Over the course of her research training, she won the first prize in the student paper competition hosted by a division of the American Psychological Association, a paper she later presented at the national convention. Upon graduation, her GPA was a perfect 4.0, a level of academic achievement she nearly duplicated in the unusually course-heavy and evaluation-intensive clinical program accredited by the APA, where she passed multiple competency examinations certifying her ability to administer, score, and interpret batteries assessing various aspects of personality and cognitive functioning. The program waived the comprehensive literature review requirement (their "equivalent" of a dissertation) after reviewing the dissertation she completed toward her doctorate in Social-Personality Psychology. She completed two externships and received letters of recommendation from training supervisors that detail performance evaluations ranging from solid to salutary. In addition to the required two externships, she volunteered for a second year of training at the US Army base where she had fulfilled her first of two externships, during which time she ministered to an above-average therapy caseload (which included therapeutically challenging PTSD clients working in the Pentagon on 9/11). Having a PhD, she was often called upon by her clinical program to teach Social Psychology, Theories of Personality, and History of Psychology to her peers as an adjunct instructor, over which time she developed an impressive teaching vita atypical of other applicants. Including her research program, she completed over 8 years and 200 credits worth of graduate coursework. To her formal training, she brings a Georgetown education and the distinction of having reached the semi-finals of the Rhodes scholarship competition. And she did it all with a visual disability. The following is a grisly account of her foray into the internship application process.
The Process
The process of applying for internship in Clinical Psychology is managed, which is to say that applicants work within the regulations and timetable laid down by APPIC, a brokering organization established to help bring applicants and internships under a common framework of expectations. APPIC operates a match service not unlike the one utilized for the medical profession, participation in which insures all players (applicants, applicant school officials, and internship sites) that everyone is in keeping with the framework of expectations regarding eligibility and application timetable. Applicants participating in the APPIC match system complete a 20 plus page questionnaire and manage a standardized electronic spreadsheet that details the hourly accounting of the their credentials as an extern, such as number of hours administering various assessment batteries and number of hours administering therapy to clients of various races and ethnicities. The faculty of the clinical program appoints one of its own to serve as the training director, a liaison among the program, applicant, APPIC, and internship sites. The training director is responsible for insuring applicant compliance with APPIC guidelines and for collaborating with the applicants to develop individualized strategies for maximizing probability of preferred placement. The program director may impose his or her own requirements on the applicant, so that the applicants find themselves constrained by multiple frameworks of expectations. The applicant must secure the approval of the training director to apply for any given internship, a negotiation complicated by the director's arbitrary or self-serving impressions of the student and where the student fits in the professional world. A student eligible for application to VA hospitals may be instructed that he or she "belongs" elsewhere (e.g., counseling centers) or should not compete with another student applying to the same site in that same year. During the months of December and January, applicants book a harried schedule of flights across the country, as they are granted an average of 6-7 interviews per the 10-12 institutions to which they applied. Internships tend to interview somewhere between one-third and one-half the applicants to their program. After the interview season has concluded, applicants submit a ranking of the internship programs to APPIC and each internship program submits a ranking of those students vying for the 3-4 available openings in its program. The APPIC computer is then used to "match" applicants with internships. There are many factors determining where an intern ends up. For example, applicant 'Jeremy,' ranked first by internship A, may end up at internship B because Jeremy did not rank internship A as high as B while other applicants also ranked highly by A ranked A higher on their list than Jeremy had ranked A on his list.
Results for NJAA
Now without further ado I will regale you with a tale so foul that...well, let's just say the APA itself (and a Fuller Theological seminary study) has issued statements acknowledging widespread discrimination by psychologists against persons with disabilities. It is consistent with my observations of how disabled persons are treated generally, but I never would have expected it of so many psychologists (especially VA psychologists serving such a large population of disabled veterans).
It is quite difficult to prove beyond a reasonable doubt a premeditated effort to discriminate against a person with a disability. Despite having scattered applications nationally across 24 internship institutions, fully twice the average, NJAA managed to procure only 9 interviews. Meanwhile, many of her peers disclosed that they had not applied outside the local metropolitan area either because they did not want to leave the city in which they were born and raised or because they were opposed to postponing marriage, pregnancy, or home ownership. I distinctly remember some of the exhortations: "They better take me. I just put down a deposit on a house!"
And to make matters worse, despite having received 9 interviews, NJAA was the only student in her program (and among only 3% of students nationally) who had not been admitted to ANY internship (i.e. did not "match"). The APPIC organization and training directors enjoy using statistics to make fine discriminations between the percentage of applicants who successfully landed their first choice of internship versus their second or third choice, which seems rather cold when you consider those applicants who ended up empty-handed.
"We are pleased to report that a total of 2,410 applicants were successfully matched to internship positions. Half (50%) of all matched applicants received their top-ranked choice of internship site, more than two-thirds (70%) received one of their top two choices, and more than four-in-five (83%) received one of their top three choices." (APPIC, 2002, www.appic.org)
88% of the applicants matched, and each applicant was ranked by an average of 5.5 different programs. NJAA (who applied to 24 sites) was left with nothing at all, remanded to a clearinghouse in the hopes she would be able to find an internship institution none of the applicants wanted. Typically, the institutions in the clearinghouse are those that offer an internship that is unfunded and unaccredited by the American Psychological Association.
But perhaps the most unsettling of all facts in this case is that, while browsing the available internship institutions in the clearinghouse, NJAA encountered a few institutions to which she applied. Do you realize yet what this means? If NJAA had been ranked at all by these institutions, even if she were ranked at the bottom of the 40-50 applicants, she would have matched there. What this means is that these institutions had not ranked her AT ALL, which is unusual and insulting. Clearly, we have at this time evidence that a group of internship institutions who at one point deemed NJAA suitable for interview developed some objection to NJAA. NJAA was further distressed by the fact these institutions did not respond at all to a second overture made by NJAA as part of the clearinghouse process to work with these institutions. Just what could have been wrong with NJAA?
All the internship institutions were aware that NJAA had a visual disability (20/200 vision). The training director at her school urged NJAA to disclose the disability on her APPIC form. Unlike many visual disabilities, which can be entirely inconspicuous, NJAA has a slight nystagmus, which is to say that her eyes shift involuntarily from side to side. The nystagmus is not as evident in NJAA as it is many others with a more dramatic nystagmus. Nevertheless, it is a physical feature the interviewers would have noticed.
There is also the question of accommodations for the disability. NJAA suffers extraordinary headaches if she is required to read normal size print and often requested from professors or Disabled Student Services at prior institutions that her reading materials be enlarged 20%. Having dealt frequently with non-compliance or duress in arranging for accommodations in university settings, NJAA learned to arrange her own accommodations (at times with the assistance of her husband). Prudently, NJAA decided not to include on the APPIC form any request for accommodations that would put her at a disadvantage. Nevertheless, during the interviews, she was frequently asked questions like 'if you do not have a license to drive, how would you arrange to get to work,' a strange question considering NJAA had been managing her time and travel her whole life and comes with excellent references. And NJAA had coordinated cross-country flights to make the interviews possible.
When all the dust settled, NJAA consulted with the administrators of the APPIC match system. The match system administrators expressed sympathy for NJAA, reporting that they have warned psychologists repeatedly about discriminating against persons with disabilities. However, match system administrators would not comply with NJAA requests to require directors to release ranking- and rationale-related information to NJAA. Match system administrators agreed that discrimination was likely and that they would levy punitive measures against the offenders if NJAA could provide smoking gun-caliber evidence, evidence which NJAA insists is easy to bury with a policy of non-disclosure.
Some Clues to What Was Coming
Throughout her college career, arranging for her accommodations was itself a Herculean task and extra-curricular distraction, often straining her relationship with disability student service coordinators who opposed her with their own restrictions and agendas. But the first serious threat to her career as a therapist occurred as she applied for her first clinical externship. NJAA must have felt like some kind of monster when the director of a university counseling center insinuated that with shifty eyes, she would not be able to maintain a warm and fuzzy impression on college-age clients. For the first time, she had been told that some aspect of her appearance over which she had no control could be considered a source of discomfort for others and thus an obstacle to therapy. This would later prove entirely unfounded, over the course of NJAA's work with dozens of clients, none of whom expressed any discomfort about her appearance or credentials. At no point in her career as an extern had her drop-out or no-show rates dropped below the staff average, but at many points were they better-than-average, with NJAA winning friendly bets with one supervisor over being able to make progress with this or that case that once proved difficult for the supervisor. Unlike the usual collection of young drones, externs that showcase immaturity within an exterior of tin, NJAA's warmth, humor, and effectiveness earned her respect and friendly distinctions from colleagues, supervisors, and clients alike. Along with highly sophisticated and diligent case conceptualizations, NJAA brings an uncanny knaack for developing rapport with clients of all backgrounds.
When NJAA sought answers from the director of the counseling center about this decision, the director, with a 'how dare you question me' attitude, turned NJAA into her school's training director, who reprimanded her and required her to compose a letter of apology to the university counseling center director (most likely out of fear this university counseling center would, as a reprisal, close its doors to other applicants from NJAA's school).
Faced with the prospect of no externship, NJAA was saved when she violated school policy by taking it upon herself to make her own externship opportunity. She networked and found a position at a military base, where her abilities were never pre-judged and eventually praised (as she was able to make inroads with clients notoriously resistant to therapeutic interventions). She developed a superb record working with clients in the military and their families and after the externship ended, she was permitted (no, invited) to remain as a therapist for two additional years as a volunteer (she eventually treated persons who worked in the Pentagon on 9/11). But despite her record, her superior credentials, and a superb letter of recommendation from the colonel, she was unable to land an internship in the match system, and evidence suggests that the disability was again the reason.
NJAA coordinated flight plans that December and January, a woman with a visual disability traveling alone to many unfamiliar cities, accompanied (at her expense) by her husband only when the hotels or sites were not accessible from the airport via cab. During one interview at a VA in Tennessee, she was told something to the effect "I have no questions for you. Your credentials are superior. You should have your pick of internships." A few days after returning home, she received a form letter from the VA director stating she was among the 25 percent of the applicants cut from further consideration and would not be ranked.
While none of the programs would disclose where they ranked her, hiding behind the policy of non-disclosure initiated by APPIC, the fact she met representatives of some of these same programs in the clearinghouse (looking for interns) reveals beyond a doubt that these sites had not ranked her at all. It is quite unusual for a site not to rank an applicant it interviewed. If any of the sites she found in the clearinghouse had ranked her AT ALL, the match system would have assigned her to one of them. She was tactful and congenial in her search for answers, deciding beforehand to explain to site directors that the information would prove invaluable should she be forced to take the year off and re-enter the match system the following year...
...She was stonewalled! At one site, the staff psychologist assigned to interview her expressed dismay that she had not earned a placement, and he requested information from his director on NJAA's behalf. But this only irritated the director. In NJAA's conversation with the director, the director alluded disapprovingly to the letter NJAA sent the staff member who interviewed her, grudgingly offering up the following as one possible explanation. (The director claimed she did not remember the committee discussion). Apparently, as the director flipped through her folder on the phone, she honed in on one written comment. It seems the interns who took NJAA to lunch (NJAA had no idea these interns were being granted any input) complained that NJAA 'asked too many questions.' It was also noted in the folder that NJAA appeared to have been anxious during the interviews, which NJAA believes to be a rather violent misinterpretation of the nystagmus. NJAA deemed these explanations a stretch to say the least.
The director at another VA in Reno, Nevada expressly stated that preference would be given to applicants who already completed work on their dissertation. This preference is reasonable, considering the dissertation siphons resources from what must be over 95% of the interns, since so few have completed their dissertation by the time of internship. NJAA made it quite clear in her APPIC form that her dissertation had already been completed (its requirement waived on the basis of having already completed a dissertation in fulfillment of the reequirements for a prior PhD). NJAA may have very well been the only applicant to this VA whose dissertation was already completed. NJAA did NOT match here. Like other VAs, the director of this VA refused to disclose information concerning exactly where NJAA ranked as well as the basis for the ranking.
There are no ballistics. No forensic evidence with which to trap directors into revealing their discrimination. You can only hope to depose them and flesh out all the inconsistencies in their account. But if they are protected by an APPIC policy of non-disclosure from having to discuss the basis for their decisions, then there is no means by which to amass the evidence needed to properly prepare a deposition. Not that NJAA hadn't tried. She encountered all sorts of stonewalling. One director treated her as if she asked them to violate an APPIC law prohibiting disclosure, when the policy simply puts release of that information at their discretion. Like legislators and ADA, the internship sites would probably not have agreed to participate in the match system without the non-disclosure policy. Another disingenuous site director even went so far as to tell an investigative arm of the Veterans Administration office that the decisions were made by a computer. I probably should not even dignify this response with any qualification, but the stone-walling should be transparent to everyone. While the APPIC computer processes the ranking of hundreds of applicants provided by hundreds of internship sites, the ranks are assigned by human beings. This psychologist was attempting to obfuscate.
And the risk and cost of a failed lawsuit looms large, not to mention the impracticality of the time frame. She needed a position in the Fall, and the VAs could have dragged out the pre-lawsuit mediation proceedings well beyond that date. Moreover, clauses in the ADA and other federal laws cap awards in ways that would have made it impossible for her to recover an estimated (by a prominent Civil Rights attorney) $100K in legal fees. (Legislators could not have supported ADA if it did not contain a clause that protected businesses from lawsuits). Thus, there is nothing to win.
Where Did NJAA End Up?
NJAA ended up uprooting herself and husband to accept an unfunded and unaccredited internship 2800 miles from her residence. Just doesn't seem like just desserts for NJAA, who drained her husband of a job in a difficult economy and her savings account of $6500 to move cross-country for an unfunded internship inconsistent with both her background and her career goals. The outcomes made little sense. Furthermore, unaccredited by the APA, this internship at a small liberal arts college the size of a high school, would disqualify her from applying for many positions in the future for which the employers require an APA accredited internship along with a doctorate from an APA accredited program. However, the internship would allow her career to move forward. It would fulfill the requirements for her second doctorate and allow her to begin applying for jobs the following year. While others recommended she consider the option to idle for a year and reapply for internship the following year, there were too many reasons not to take this course of action:
1. There was no reason to believe that any correctible deficiency with respect to a class of credentials (i.e., experience, education, interview performance) was responsible for the failure to match. NJAA had already bested many of her rivals with two credentialling factors: (a) a volunatary third externship and (b) a prior doctorate in a related field.
2. If attitudes toward her disability were the cause of her plight as she suspected, no amount of waiting and re-applying and additional experience would help.
3. At the age of 32, she is a mature student. Unlike her whiny cohorts who insist on pregnancy and home ownership in their early to mid-20s, NJAA delayed these goals in deference to her career priorities in pursuing two doctorates and a third externship. But she was getting older, and with age comes the painful awareness of an increasing risk of birth defects, something I believe psychologists should respect given their objections to persons with disabilities.
While she deeply respects the program staff and administrators at her current internship and finds her experiences surprisingly educational, the lack of accreditation will limit her job opportunities. Moreover, as an intern interviewing next-year's applicants to this unfunded, unaccredited site, she became intimately acquainted with the caliber of the students who share her plight, reminding her that she never belonged in the clearinghouse. Located in the hub of PC country, the unaccredited site, which to their credit seeks out "interesting applicants," receive applications from many students who openly celebrated their own alternative lifestyles -- students who seemed to identify wholly with their sexuality -- students who "came out" in their application essays. I have this sinking feeling that, had I been an applicant, my essay on a life of dreaming and dream research might not have interested them and yet I would have been a serious candidate had I showed up to my interview in drag. I raise this point because now that NJAA's internship is coming to an end, she is applying for counseling center positions and lowly post-docs, receiving only 2 interviews in 24 attempts.
Recent Virginia Counseling Center Fiasco
The director of the the counseling center at a state school in rural Virginia, during a phone conversation in which he invited NJAA to an interview, expressed extraordinary delight over the prospect of having her fly cross-country (at her own expense) on one week's notice to interview for a one-year post-doctoral position. NJAA arrived at the site, where she interviewed the same day as two competing applicants, a young woman holding the school's PRE-doctoral position (i.e., an internal candidate of sorts) and one woman who spoke endlessly of how she needed the position because she was pregnant and her husband recently found employment in that area. Naturally, NJAA's husband also flew at their own expense to assist in the transportation of NJAA to her interview in this rural Virginia town. In the pre-interview phone discussion, it was revealed that funding for an additional position might become available, in which case offers would be made to 2 of the 3 candidates. NJAA just learned that she was NOT selected for the position despite the fact the director expressed exuberance over the prospect of having NJAA infuse the counseling center with new ideas and with a clinical style that was remarkably similar to his own.
NJAA was notified of the decision by e-mail on Friday. The e-mail did not contain any clues as to the basis of the decision but the tenor of the e-mail was distant and unfeeling, which was inconsistent with the tenor of previous conversations with the director. After absorbing the decision over the weekend, NJAA phoned the director, who candidly offered this befuddling explanation, described by J. Wyatt Ehrenfels.
The director told her that he was upset that the "rest of the committee did not see what he saw." They said she lacked energy and initiative and that she was too reserved. Anyone vaguely familiar with NJAA knows this sounds like nonsense, and NJAA's colleagues, including the director of the counseling center where she currently serves as an intern, reported that this explanation did not make any sense. In fact, it may have made more sense if they had decided to criticize her for an overabundance of energy and initiative (as a previous internship site had done in the past). NJAA has an almost childlike enthusiasm for her work, which was more than apparent to the director as well as to her husband in the hours after the interview. "She was wound up. When she recapped the conversations, both in terms of what was said and how she said it to me...it was obvious to me there was energy then and energy now. If anything, she thought some of the committee members had not engaged her enough."
Strangely enough, there was also criticism that NJAA was not polished. Although she does lack the tin exterior of some of her competitors, her competitors usually lack her warmth and, well, her energy. "As I understand it," related Ehrenfels, "her competition included an inhouse pre-doc and a young woman with a compulsive penchant for indiscriminate name-dropping and discussion of her husband and pregnancy. Where's the polish in that?" NJAA broached mature and advanced institutional issues like HIPAA compliance during an interview performance that capped superior credentials, experiences, and references. Bemused friends of NJAA raised the question, "if there was any polish lacking, was it truly in the exchange or were committee members reacting negatively to her nystagmus and fair skin."
While the director could not quite fathom the committee's impressions, he did think they should have taken the jet lag into account. NJAA was the only applicant flying a 2800 mile red eye and one member did gleefully note after examining NJAA's wristwatch that "she was still on Pacific time."
The committee also mentioned that the counseling site will be transitioning to a more psychodynamic orientation, something no one mentioned prior to, or during, the interview. While the committee, and this is quite typical, claimed to be acting in NJAA's best interests when they denied her the position, reporting that NJAA would not have benefited from a psychodynamic environment, no opportunity was given to NJAA to state whether she would have fit into that kind of counseling center. And if the odd statement is true and the site intends to flip some kind of psychodynamic switch, then they should have never asked her to fly out in the first place. The director, a self-professed 'self psychologist,' celebrated during the interview the extent to which NJAA's ideas lent themselves to self psychology.
Friends and colleagues of NJAA were skeptical about taking the explanations at face value. "Ultimately, we don't know who they took. NJAA had mentioned immediately after the interview that one interviewer seemed to give her a very inhospitable environment, a very cold shoulder, and we wondered then whether there may have been some interviewers who were favorably pre-disposed to the internal candidate and who felt threatened by the sudden emergence of this highly credentialed, mature, experienced candidate. They may have been looking for a reason to reject her. But there was no mention in the rejection e-mail or subsequent phone discussion with the director of that possible second position. Suddenly, there was amnesia about it, prompting us to speculate that maybe she was ranked third of the three candidates, which would be consistent with those nightmarish experiences with VA hospitals during the internship match process. Just how little energy and polish does someone have to show to overshadow all these credentials? How little energy and polish does someone have to show to overshadow all these references commending the candidate on her polish and energy? This is hogwash. They are either hiding some prejudice against her looks or they need to take a little of that so-called psychodynamic acumen of theirs and take stock of their unconscious. The only position this woman ever received in her clinical career was the unfunded, unaccredited internship for which she interviewed over the phone.
NJAA was also interviewed recently for a position in a university counseling center in the midwest. Despite the fact the counseling center staff is already a mini-Rainbow coalition serving a student population that is well over 90% white, the director expressed a preference for minority candidates and informed NJAA that disability is officially registered as a minority at this particular university. NJAA was flown out at her own expense, but she was told that she could expect to be reimbursed by the university. Over a dinner interview, the staff expressed less of an interest in her dual doctorates than in her prior association with a prominent APA division member who once served as the head of the university's psychology department. But the primary focus of the interview was her disability. NJAA was taken aback when the staff was informed that she had agreed to certain administrative duties relevant to her status as a person with a disability. NJAA had never known of such responsibilities and although she did not want to be placed in the disabled role, she played along to preserve what appeared to be an ebullient atmosphere. Two weeks after the conclusion of the interview, NJAA took to e-mailing the director, as she and the director has exchanged e-mails and had spoken by phone prior to the interview. The director never replied. Eventually, NJAA had to make a decision about where she would live in the Fall, and with August 1st having come and gone, she and her husband could no longer wait on clues from the university. She made arrangements to move elsewhere but did not inform the university so as not to take herself out of the running. In mid-August, after unanswered e-mails and phone calls, NJAA finally received a letter of rejection in snail mail stating that the university was "no longer pursuing her candidacy." In an effort to learn ways to improve her interviewing skills and to learn of the factors contributing to the decision, NJAA phoned the director. Rather than return the call, the director sent NJAA a curt email stating, "I was a little confused when I received your message yesterday, because I'd expected you would have gotten a letter from me." NJAA refers to the new communication style as the "click n' split." She acknowledges that while this may reflect a broad pattern of exploitation in which this university rudely disposes of the candidates for whom they have no more use, she admits to feeling that the sudden shift in communication post-interview (when the university caught its first glimpse of her) begs all the usual questions about discrimination. Incidentally, to this day, NJAA has not seen the $150 the university owes her.
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